There are concerns regarding postoperative infections following laparoscopic colectomy with intracorporeal anastomosis. Thus, in this study, we aimed to determine the optimal preoperative bowel preparation to reduce postoperative infectious complications in patients undergoing laparoscopic colectomy with intracorporeal anastomosis. This secondary analysis of the ICAN study—a multicenter, retrospective cohort study involving 46 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery—included 615 patients with colon adenocarcinoma undergoing laparoscopic colectomy with intracorporeal anastomosis between January 2020 and December 2021. Patients were analyzed after applying eligibility criteria and propensity score matching based on age ≥ 65 years, sex, body mass index ≥ 30, American Society of Anesthesiologists Physical Status, diabetes, and the number of intracorporeal anastomosis cases previously performed at the institution. Among them, 312 received combined oral antibiotics and mechanical bowel preparation, whereas 156 received other preparations (mechanical preparation alone, oral antibiotics alone, and no preparation). The primary outcome was surgical wound infection incidence (Clavien–Dindo grade ≥ II) at initial discharge. Secondary outcomes included intraperitoneal infections, anastomotic leakage, ileus, and postoperative hospital stay. Surgical wound infection (1/312 [0.3
Mid-pregnancy cervical length (CL) has limited predictive performance for spontaneous preterm birth (sPTB) in the normal range. The uterocervical angle (UCA) is a promising marker, but evidence regarding late-pregnancy UCA and its longitudinal change is limited. We evaluated UCA in mid- and late-pregnancy and the
Background The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear. Methods This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy. Results A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0-I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence. Conclusions Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.
LBA3508 Background: Observational studies suggest aspirin benefits in colorectal cancer (CRC), but adjuvant evidence remains limited. In unselected populations, phase III trials have not shown a clear benefit, while biomarker-selected studies suggest a benefit in PI3K-altered tumors. EPISODE-III evaluates whether low-dose aspirin improves disease-free survival (DFS) in unselected stage III CRC receiving standard adjuvant chemotherapy. Methods: EPISODE-III is a multi-institutional, two-arm, randomized, double-blind, placebo-controlled phase III trial at 36 institutions in Japan. Eligible patients (20–80 years; ECOG PS 0–1) with histologically confirmed, R0-resected stage III adenocarcinoma from the cecum to upper rectum (lower rectum excluded) after D2/D3 lymph node dissection were randomized 1:1 to low-dose aspirin (100 mg once daily) or matched placebo for 3 years, in addition to standard adjuvant chemotherapy (capecitabine, mFOLFOX6, or CAPOX). Randomization was balanced by institution, sex, stage (IIIA/IIIB/IIIC), and planned oxaliplatin use. The primary endpoint was DFS (event: relapse, second cancer, or death). Secondary endpoints included overall survival (OS), relapse-free survival (RFS), relative dose intensity (RDI) of aspirin and placebo, and safety. The planned sample size was 880 (279 DFS events), providing 80% power with a one-sided α = 0.05 to detect hazard ratio (HR) of 0.741 (assumed 3-year DFS 74% vs. 80%). Results: Between Mar 2018 and Oct 2022, 882 patients (placebo 442; aspirin 440) were enrolled. At the data cutoff (Oct 2025), the median follow-up for all randomized patients was 4.0 years, with 231 DFS events (placebo 124; aspirin 107). Baseline characteristics were balanced (median age 65 vs. 64 years; pIIIA/IIIB/IIIC 19/63/18% vs. 19/62/19%; planned oxaliplatin-containing regimen 70% vs. 71%). Three-year DFS was 75.4% with placebo and 78.8% with aspirin (+3.4%); the primary endpoint was not met (HR 0.84, 95% CI 0.65–1.09; one-sided p=0.0987). DFS, RFS, and OS are shown in the Table. Grade ≥3 adverse events were similar between arms, and grade ≥3 aspirin-related adverse events were <1% (lower GI bleeding n=4). One treatment-related death was observed in the aspirin arm during chemotherapy (ischemic heart disease). RDI was high and comparable (median 98.6% in both arms). Conclusion: Low-dose aspirin added to standard adjuvant chemotherapy did not significantly improve DFS in unselected stage III CRC. However, a numerical DFS improvement with good tolerability was observed. Exploratory biomarker analyses including PI3K/PIK3CA are ongoing and will inform a planned collaborative meta-analysis of randomized trials. Clinical trial information: jRCTs031180009. 3-year (%)placebo vs. aspirin HR (95% CI) P (one-sided) DFS 75.4 vs. 78.8 0.84 (0.65–1.09) 0.0987 RFS 77.2 vs. 79.5 0.87 (0.66–1.14) - OS 96.6 vs. 95.2 1.02 (0.65–1.60) -
